1972606275 NPI number — HECTOR Y RODRIGUEZ PC

Table of content: (NPI 1972606275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972606275 NPI number — HECTOR Y RODRIGUEZ PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HECTOR Y RODRIGUEZ PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCE UROLOGY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972606275
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15138 LEVAN RD
Provider Second Line Business Mailing Address:
SUITE 38
Provider Business Mailing Address City Name:
LIVONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48154-5027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-779-2133
Provider Business Mailing Address Fax Number:
734-779-2154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15138 LEVAN RD
Provider Second Line Business Practice Location Address:
SUITE 38
Provider Business Practice Location Address City Name:
LIVONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48154-5027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-779-2133
Provider Business Practice Location Address Fax Number:
734-779-2154
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
HECTOR
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
734-779-2133

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  4301050645 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4072034 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P41692 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 126783 . This is a "PREFERRED CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 340H231630 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 340018996 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 123783 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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